- The comparative analysis of the open and laparoscopic appendectomy in children
The comparative analysis of the open and laparoscopic appendectomy in children
Paediatric surgery.Ukraine.2019.4(65):43-47; DOI 10.15574/PS.2019.65.43
A.A. Pereyaslov1, A.A. Dvorakevych2, A.I. Bobak1, M.M. Mykyta2, O.M. Nykyforuk1, R.I. Datz1, N.M. Opikan1, Z.M. Pereyaslova3
1Danylo Halytsky Lviv National Medical University, Ukraine
2Lviv regional children’s clinical hospital «OXMATDYT», Ukraine
3Lviv 3rd city clinical hospital, Ukraine
For citation: Pereyaslov AA, Dvorakevych AA, Bobak AI, Mykyta MM et al. (2019). Comparative analysis of the open and laparoscopic appendectomy in children. Paediatric Surgery.Ukraine. 4(65): 43-47. doi 10.15574/PS.2019.65.43
Article received: Sep 08, 2019. Accepted for publication: Nov 30, 2019.
Laparoscopic appendectomy step-by-step widely introduced in the practice of pediatric surgeons. Besides of the well-known advantages of mini-invasive interventions, the expediency of laparoscopic appendectomy in children still debated.
Aim of the work was to compare the results of open (OA) and laparoscopic appendectomy (LA) based on the own experience.
Materials and Methods. This study based on the results of surgical treatment of 3171 children with acute appendicitis, which were operated in 1st surgical department of Lviv regional clinical hospital «OXMATDYT» during 2009-2018 years. OA was applied in 2879 (90.8%) and LA – in 292 (9.2%) of patients. We analyzed the following data: accuracy of intraoperative diagnosis, duration of surgery, antibiotics therapy at the postoperative period and postoperative ileus; complications in the early postoperative period. Besides that, the results at the remote period were evaluated in 1032 (32.5%) of patients.
Results. The accuracy of the intraoperative diagnostic of the form of appendicitis was higher in case of LA compared with OA – 68.8% and 59.3%, respectively. Duration of LA was longer than OA, however this difference statistically was insignificant (р>0.05). The restoration of the gut motility was faster after LA vs. OA – at 21.52±1.39 and 29.5±0.68 hours, respectively. It’s determined the earlier starting of the enteral nutrition – at 1.22±0.57 and 2.32±0.72 days, respectively. The complications’ frequency in the early postoperative period had no statistical difference in cases of LA and OA, by that LA associated with the decreasing of the negative consequences and complications at the remote period.
Conclusions. LA accompanied by the faster restoration of the gut function that promoted for the earlier start of enteral nutrition and abolishing of antibacterial therapy. According to the frequency of complications both methods had no significant differences at the early postoperative period, however in LA these complications are less. At the follow-up, LA associated with the significant decrease of the quantity of negative consequences and complications.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
Key words: children, acute appendicitis, appendectomy, laparoscopy.
1. Ali R, Anwar M, Akhtar J. (2018). Laparoscopic versus open appendectomy in children: a randomized controlled trial from a developing country. J Pediatr Surg. 53 (2): 247-249. https://doi.org/10.1016/j.jpedsurg.2017.11.022; PMid:29223666.
2. Anderson SA, Beierle EA, Chen MK. (2014). Role of laparoscopy in the prevention and in the treatment of adhesions. Semin Pediatr Surg. 23(6): 353-356. https://doi.org/10.1053/j.sempedsurg.2014.06.007; PMid:25459441
3. Bisgaard T, Kehlet H, Oehlenschlager J, Rosenberg J. (2014). Acceptable nationwide outcome after paediatric inguinal hernia repair. Hernia. 18(3): 325-331. https://doi.org/10.1007/s10029-013-1077-8; PMid:23508870
4. Buicko JL, Parreco J, Abel SN, et al. (2017). Pediatric laparoscopic appendectomy, risk factors, and costs associated with nationwide readmissions. J Surg Res. 215: 245-249. https://doi.org/10.1016/j.jss.2017.04.005; PMid:28688655
5. Escolino M, Becmeur F, Saxena A et al. (2018). Infectious complications after laparoscopic appendectomy in pediatric patients with perforated appendicitis: is there a difference in the outcome using irrigation and suction versus suction only? Results of a multicentric international retrospective study. J Laparoendosc Adv Surg Tech A. 28(10): 1266-1270. https://doi.org/10.1089/lap.2018.0061; PMid:29906215
6. Gasior AC, St Peter SD, Knott EM et al. (2012). National trends in approach and outcomes with appendicitis in children. J Pediatr Surg. 47(12): 2264-2267. https://doi.org/10.1016/j.jpedsurg.2012.09.019; PMid:23217886
7. Gorter RR, van der Lee JH, Heijsters FACJ et al. (2018). Outcome of initially nonoperative treatment for acute simple appendicitis in children. J Pediatr Surg. 53(9): 1849-1854. https://doi.org/10.1016/j.jpedsurg.2017.12.012; PMid:29395151
8. La Plant MB, Saltzman DA, Rosen JI et al. (2019). Standardized irrigation technique reduces intraabdominal abscess after appendectomy. J Pediatr Surg. 54(4): 728-732. https://doi.org/10.1016/j.jpedsurg.2018.06.017; PMid:30025605
9. Levin DE, Pegoli WJr. (2015). Abscess after appendectomy: Predisposing factors. Adv Surg.49: 263-280. https://doi.org/10.1016/j.yasu.2015.03.010; PMid:26299504
10. Li P, Han Y, Yang Y et al. (2017). Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients: Laparoscopic versus open surgery for appendiceal abscess. Medicine (Baltimore). 96(30): e7514. https://doi.org/10.1097/MD.0000000000007514; PMid:28746196 PMCid:PMC5627822
11. Liu Y, Cui Z, Zhang R. (2017). Laparoscopic versus open appendectomy for acute appendicitis in children. Indian Pediatr.54(11): 938-941. https://doi.org/10.1007/s13312-017-1186-z; PMid:28849763
12. Masoomi H, Nguyen NT, Dolich MO et al. (2014). Laparoscopic appendectomy trends and outcomes in the United States: data from the nationwide inpatient sample (NIS), 2004-2011. Am Surg. 80(10): 1074-1077.
13. Nataraja RM, Panabokke G, Chang AD et al. (2019, Aug 30). Does peritoneal lavage influence the rate of complications following pediatric laparoscopic appendicectomy in children with complicated appendicitis? A prospective randomized clinical trial. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2019.08.039; PMid:31519360. Epub ahead of print.
14. Nordin AB, Diefenbach K, Sales SP et al. (2019). Gangrenous appendicitis: No longer complicated. J Pediatr Surg.54(4): 718-722. https://doi.org/10.1016/j.jpedsurg.2018.10.064; PMid:30551843
15. Park HC, Kim MJ, Lee BH. (2017). Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis. Br J Surg.104(13): 1785-1790. https://doi.org/10.1002/bjs.10660; PMid:28925502
16. Podda M, Gerardi C, Cillara N et al. (2019). Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children: a systematic review and meta-analysis. Ann Surg. 270(6): 1028-1040. https://doi.org/10.1097/SLA.0000000000003225; PMid:30720508
17. Rautava L, Rautava P, Sipila J, Kyto V. (2018). Occurrence and treatment of pediatric appendicitis in Finland 2004-2014. J Surg Res. 232: 33-38. https://doi.org/10.1016/j.jss.2018.06.010; PMid:30463737
18. Rollins KE, Varadhan KK, Neal KR, Lobo DN. (2016). Antibiotics versus appendicectomy for the treatment of uncomplicated acute appendicitis: an updated meta-analysis of randomised controlled trials. World J Surg. 40(10): 2305-2318. https://doi.org/10.1007/s00268-016-3561-7; PMid:27199000
19. Sauerland S, Jaschinski T, Neugebauer EA. (2010). Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Syst Rev. Issue 10. Art. No.: CD001546. https://doi.org/10.1002/14651858.CD001546.pub3; PMid:20927725
20. Talan DA, Saltzman DJ, Mower WR et al. (2017). Antibiotics-first versus surgery for appendicitis: a US pilot randomized controlled trial allowing outpatient antibiotic management. Ann Emerg Med. 70(1): 1-11. https://doi.org/10.1016/j.annemergmed.2016.08.446; PMid:27974169 PMCid:PMC5616169
21. Ure BM, Spangenberger W, Hebebrand D et al. (1992). Laparoscopic surgery in children and adolescents with suspected appendicitis: results of medical technology assessment. Eur J Pediatr Surg. 2(6): 336-340. https://doi.org/10.1055/s-2008-1063473; PMid:1477059
22. Yamanaka S, Skarsgard ED, Goldman RD. (2018). Conservative therapy for appendicitis in children. Can Fam Physician. 64(8): 574-576.
23. Yu TC, Hamill JK, Evans SM et al. (2014). Duration of postoperative intravenous antibiotics childhood complicated appendicitis: a propensity score-matched comparison study. Eur J Pediatr Surg. 24(4): 341-349. https://doi.org/10.1055/s-0033-1349055; PMid:23801354
24. Zani A, Hall NJ, Rahman A et al. (2019). European Paediatric Surgeons’ Association survey on the management of pediatric appendicitis. Eur J Pediatr Surg. 29(1): 53-61. doi: 10.1055/s-038-1668139.